A case of delayed-onset pulmonary barotrauma in a scuba diver.

A 23-yr-old male scuba diver was admitted to the hyperbaric chamber of the Polish Army Training Centre of Divers and SCUBA Divers for treatment of pneumomediastinum and possible decompression sickness. Medical history suggested a case of pulmonary barotrauma with delayed and exacerbated symptoms. About 36 h after the onset of symptoms the patient was treated successfully according to U.S. Navy Treatment Table 6-A. A recurrence of symptoms was observed more than 3 d after the initial hyperbaric therapy. Signs and symptoms suggested the presence of air in the vessels of the nervous system, and possibly in the heart muscle and bones of the upper limbs. A second recompression therapy began according to method III of the Polish Navy Treatment Tables. Adjunctive therapy included intravenous aspirin, steroids, isosorbide dinitrate, and fluids. Symptoms resolved and did not recur after this second hyperbaric therapy.